Os Centros de Especialidades Odontológicas como suporte da atenção básica: uma avaliação na perspectiva da integralidade

The public dental services in Brazil were limited, practically, to the basic care, so that the specialized services acted, up to 2002, no more than 3,5% of the total of clinical procedures. That lower offer reveals the difficulty of continuity of the attention, that is, the comprehensiveness in the assistance, particulary, the reference and counter-reference system. Brasil Sorridente search to supply those needs when proposing Speciality Dental's Centers(CEOs Centros de Especialidades Odontológicas, Brazil) to compose the services of average complexity. In 2005, Ministry of Health enabled the three CEOs of Natal, located in the North II, East and West Sanitary Districts. This investigation evaluated the implantation of these CEOs, as support of the family health care teams, in the perspective of organization of the services in assistencial nets in Natal/RN. It was a study of evaluation, with qualitative approach and some quantitative data as contribution. Dentists, users and managers were interviewed to identify and to understand their perceptions, relationships and experiences in the daily of the services. The conceptual base that orientated the investigation was the principle of comprehensiveness, in its operational sense of the hierarchization in health attention levels. The collection of data was done with documental research, direct observation and semi-structured interview. The analysis was accomplished by triangulation of the extracted content from the used techniques and sources of interviewed groups depositions, looking for theoretical-conceptual support in specific bibliography. The results pointed aspects that go away from the comprehensiveness like: low resolution of problems in the basic net; little valorization of the space in the health units; traditional models of access to health services, insufficient offer for some specialties, compromising the reference and counter-reference system; practices centered in procedures in the CEO; bureaucratic directions from basic care to the specialized service; disintegrated and disjointed system among levels of attention; disrespect to the municipal protocol. On the other hand, there is an approach of compreensiveness in situations like: increase of the access and covering in the Family Health Strategy (ESF Estratégia Saúde da Família, Brazil); larger approach between professional and user; tendency to the quantitative and qualitative growth of specialized actions; punctual initiatives of relationships among levels; existence of protocol to guide professionals

Bioética e odontologia: um perfil dos problemas éticos vividos por cirurgiões-dentistas

Bioethics studies human behavior in the fields ofbiological sciences and health care. Tt strives for humanization in health services along with promoting the rights of patients. In view of the lack of dental research dealing with this topic, the present study was undertaken to identify, from the viewpoint of dental surgeons, ethical problems experienced in dental practice,understand how they occur and how professionals deal with them. It is a descriptive exploratory investigation within a qualitative approach. Empirical material was collected through semi-structured interviews performed with 15 dental surgeons who work both in private and public practice in the state of Rio Grande do Norte, Brazil. The content of the interviews was systemized and organized, resulting in the identification of topics, from which were grouped the ethical problems reported by the participants. The resu1ts indicate that many of the ethical problems coincide with infringements of the norms and mIes of the Dental Code of Ethics, confirming a dental ethic acquired during professional formation and therefore, inadequate for solving the problems that emerge in professional practice. Other questions stand out such as low salaries, competition and poor working conditions. Associated to these problems are lack of commitment and professional responsibility with the patients. Concem with maintaining user autonomy, guaranteeing access to specialized services, and the need for performing only procedures for which they are technically qualified arise in the responses, leading to difficulties in consolidating the principIes proclaimed by bioethics: autonomy, justice, nonmaleficence and beneficence. We concluded that the ethical problems identified in professional practice need to be understood beyond the dental dimension, towards a human approach. It is therefore necessary to incorporate health care management technologies into health practices, including dentistry, which implies recognizing the difTerent dimensions that surround individuaIs, that is, social, economic, political and cultural

O ambulatório de Saúde Mental no contexto da Reforma Psiquiátrica em Natal/RN

The years 1990 disclose the consolidation of the Brazilian Psychiatric Reform project, assumed as official politics by the Health Department, also stirring up discussions, lines of direction and new ways of care. Substitutive services to the psychiatric hospital as CAPS, conviviality centers, therapeutical residences and ambulatory clinics are implemented. This work analyzes the relations that the Specialized Ambulatory Clinic of Ribeira establishes to the services of Mental Health of the public system in the city of Natal/RN, as well as its adjustment to the proposal of the Psychiatric Reform. Through semi-structured interviews and observation, it was possible to gather data which allowed picturing a general characterization of the service: activities, technical group, joint with other institutions, daily routine organization. Such institution develops activities that surpass the traditional character of a clinic- in other words, the psychological/medical appointments - and it mainly greets the ones proceeding from CAPS and psychiatric hospitals. It offers group activities, psychiatric appointments, therapeutical workshops, sheltering and strolls, among others. The institution is composed by a multi-professional team of psychiatrists, psychologists, occupational therapists, nurse s aide and art-educator. The joint of this service with others that make part of the Mental Health Assistance network in Natal is incipient. Due to this fact, some actions and activities that could and should be developed together are just not. Although facing difficulties, the professionals of the Ambulatory Clinic of Ribeira are able to achieve good results and establish care in Mental Health that prioritize sheltering, listening and respect to the user s individuality. The Ambulatory Clinic of Ribeira is organized according to the paradigm of the Psychiatric Reform. Therefore, it offers an attention that stimulates the re-socialization of the users and the exercise of the citizenship and autonomy of those

O Serviço Ambulatorial Móvel de Urgência (SAMU) no contexto da reforma psiquiátrica: em análise a experiência de Aracaju/SE

This research investigated professional practices from Mobile Urgency Care Service (Serviço Ambulatorial Móvel de Urgência - SAMU) at psychiatric cases of the city of Aracaju/SE, Brazil and its possible articulations to psychosocial services network. The regulation no. 2048 of 11/05/2002 from Ministry Health establishes National Urgency Policy and designates that psychiatric cases are SAMU's responsibility. Then, it is necessary to propose an analyze of psychiatric urgency service under anti-asylums social movements standpoint, mainly because this service is responsive in assisting a person in crises. Fieldwork was developed in two phases. First one was made with SAMU workers and the information were produced by recorded semi-structured interviews. Results of this first phase indicate that urgency psychiatric conception from SAMU workers is based on aggressiveness concept; delays at psychiatric cases support and low training in mental health care which means several difficulties to emergency service. Although, we noticed that SAMU use asylum procedures at psychiatric cases like ropes and odder instruments to contain people. The second step of our research was to attend meetings to build a new psychiatric urgencies protocol for SAMU to define practices to auxiliaries, vehicular conductors and medical support regulation. Therefore, open interviews were accomplished with some participators and follows-up to psychiatric case on board of SAMU's cars. Afterwards we discussed how the urgency paradigm, that influence the protocol draw and as consequence distort what we believe is the essentially function of this device, that is to give care support to persons in crises and produce articulation to psychosocial services network

Doadores de sangue: qualidade de vida e atendimento em hemocentro de Natal / RN

The context of blood donation in Brazil faces problems since the start of its operations in the 1940, in the beginning the biggest obstacle was obtain safe and qualified blood, and then, established criteria for donations, the barrier is the low number of suitable candidates for donation. This suitability is associated with the good health of those who goes to the services of blood banks and the return of the donor is often conditioned by the way care is given and perceived by the user. The quality of life, defined as a perception that a person has of her/his position in the world, can influence the health and emerges as a way to focus on the subjectivity in a context dominated by objective and practical exams; listen to the views about the received services increases the focus on the user and provides feedback to the institution, guiding and planning its future actions. The purpose of this study was to verify the quality of life in blood donors and their perceptions of care in a blood center in Natal/RN. This is a descriptive cross sectional study conducted with blood donors from Dalton Cunha Barbosa blood center. The used protocols were: a structures questionnaire with questions on sociodemographic and services perception data, and SF-36 quality of life instrument. The sociodemographic and SF-36 data ware analyzed using descriptive and inferential statistics, using the statistical package PASW 18.0; those related to treatment were submitted to thematic content analysis. The results revealed a sample mainly composed by men, married people, who attended high school and had already made previous donations, with the first two groups returning more often for donations. The scores of the SF-36 confirm the certificated of good health of the screens, beind high in all areas and featuring a healthy population; statistically significant differences were denoted between sexes, levels of education and marital status. The speeches about the service were mostly positive and had as main focus acess, agility, technical aspects and subjective feelings. The data regarding the Rio Grande do Norte blood donors profile confirmed some characteristics of the Brazilian ones, those data of the SF-36 were similar to those found in studies with healthy groups and the impressions about the care received show similarities with national and international studies about the attendance at blood banks

Sofrimento solitário, mal-estar compartilhado :um estudo sobre a doença dos nervos

Nerves has been perceived as generalized suffering with multiple complaints, such as pain and other physical sensations, usually followed by symptoms of anxiety and/or depression. Even after medications have been prescribed, mainly psychotropic drugs to reduce these symptoms, exams aiming to discover the causes of the disorders, and a significant referral to health services, the problem tends to get progressively worse. The objective of this study is to characterize the diseases of clients who complain of nerves at the Unidade Mista de Felipe Camarão, Natal/RN, through in depth interviews, allowing for the clarification of ideas, beliefs and the meanings attributed to nerves by that person; to identify the symptoms and to know how they interfere in daily activities; to investigate the causes attributed to the problem and their relation to the biographical and psychosocial context of the patient. Thirteen women, health service clients, aged 30 to 59 years old, participated in the research. It was observed that they perceive, feel and act in unique ways with relation to symptoms, as well as to the attributed explanations and treatments given, showing the influence of life conditions, family context and their own subjectivity. Daily concerns and overwhelming responsibilities in the domestic environment, which usually stem from their precarious survival conditions, as well as marital conflicts motivated by the inequity of gender relations, contribute to trigger this type of suffering. The methodology of the research itself proved to be crucial to the comprehension and understanding of the meanings attributed to the complaints as well as to the argumenting process and the redefinition of the illness experience. Therefore, the importance of interdisciplinary intervention must be emphasize and specially the role of listening as relevant intervention resource

Fatores socioeconômicos contextuais associados à condição bucal de adolescentes no Brasil

Many surveys are conducted comparing oral health conditions with individual variables, such as socioeconomic and demographic factors. However, in the same way that individuals differ among themselves, the groups also have their own characteristics and the effects of this differentiation must be researched. Brazil, despite being one of the major economic powers of the world and shows an improvement in the average value of its health indicators, is also one of the most unequal and remains among the countries with the greatest health inequities. The purpose of this study was to investigate the importance of social determinants on the contextual level oral health among Brazilian adolescents, population not much researched by the literature. The research was made using an ecological approach in order to identify possible inequalities between cities and capitals. Using data from SBBrasil 2010 it was evaluated less common outcomes (loss of first molar, dental care index and T-Health) which provide information on the degree of morbidity of caries and health level of dental tissues, in addition to analyze the related services. The association of these oral health indicators with socioeconomic factors such as income, employment, education and inequality, collected from Census 2010, was analyzed by simple and multiple linear regressions. The study included the 27 state capitals and four clusters representing the municipalities of the country. It was possible to see better access to services in locations with better income distribution. However, the strong association of contextual factors related to poverty, low levels of education and poor housing and jobs with poorer levels of oral health in adolescents seems to overshadow the effects of income inequalities on dental caries in the country. In some locations, particularly within the North and Northeast, whichever one keeps dentistry mutilating, whose effects are already noticeable in its adolescent population. Access to restorative services in Brazil remains limited and unequal. The results of this study highlight the inequities in oral health in the country and show the need of the inclusion of new perspectives on the traditional approach of Preventive Dentistry and education models in Dentistry. Tackling health inequalities in oral health in the country requires the cooperation of various actors involved in the process and the inclusion of oral health in the context of overall health. The social determinants approach, as well as evaluating the distribution of oral diseases in the country and its inclusion in the context of overall health, should guide the implementation of programs and oral health practices in order to contribute to the reduction of inequalities

Avaliação da satisfação das usuárias sobre a atenção à saúde da mulher no Rio Grande do Norte

This work discusses the evaluation of the satisfaction of the users on the women health care focusing on the quality of the primary care in the State of Rio Grande do Norte-BR. The main objective of this research is evaluate the satisfaction of the users about the actions applied to women health in the primary health care in Rio Grande do Norte, observing the information available through the Programa de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB). The specific objectives are: the evaluation of aspects related to women health; the evaluation of the specific actions related to welcoming the pregnant and; the evaluation of the information related to the postpartum. This dissertation is characterized as an evaluative research made through a multicentric transversal study, using a quantitative approach, which is part of the External Evaluation of the PMAQ-AB in the State of Rio Grande do Norte, made by the Federal University of Rio Grande do Norte. Some secondary data of the interviews with the users who were in the Basic Health Units were used during the External Evaluation of the PMAQ-AB in Rio Grande do Norte. The sample was collected following these criteria: the users that were in the Basic Health Units to attend to any procedure; they must had used the services for at least one year; and they must had agreed to participate the research. The ones that were attending to the services for the first time and the ones that did not use the services for at least 12 months were excluded from the sample. To the data collection it was used a chart of variables/indicators with the following information to the analysis: Women Health Care, Specific Care of the Pregnant and Information about he postpartum. The descriptive analysis of the data were made through absolute and relative frequencies of the variables using the software Statistic Package for Social Sciences (SPSS) for Windows, version 22.0.0. The results show a positive picture of the satisfaction of the users about the actions of the primary healthcare in women health in the State of the Rio Grande do Norte. Another important analysis is the integration of the primary health care with other points of the Healthcare System aiming to reorient the Model of Healthcare as a starter of the access and quality of the services given to the users. Therefore, the evaluation of the satisfaction of the users in health care is essential among all the agents involved in the process of consolidation of the Unified Health System SUS. Also having the need of rethinking the professional practice, reorganizing the processes of work of the multiprofessional teams in health care, enabling financial resources, inputs and materials, planning and systematizing new actions of healthcare aiming to ensure a perfect health care to the people

O Serviço Social nas operadoras de planos privados de assistência à saúde: demandas, atribuições e respostas profissionais

The present study deals with the exercise of professional social workers in private health care plans registered with the Regional Council of Medicine/RN, in the city of Natal/RN, with regards to the demands/tasks, work conditions, and the professional response, given the climate of restructuring the capital. The set of socio-historical transformations, as a results of the dynamic capitalist, is a process of new configurations in relation to state and society that interfere directly in relation to working conditions, social rights historically won by workers. In this context, the operator of health plans arises as a possibilities to provide services in health, through the logic of the market, in which the subjects of law, become consumers contributing to the displacement of the responsibilities of the State. Obligating workers to lessen the burden with the reproduction of their workforce. This involves changing societal context for social service, since it is one of the professions that are active in terms of the immediate social issue, and come as part of the collective worker. From qualitative research based on a theoretical and methodological perspective and critical dialectics, it was possible to unveil some features and trends of the exercise of(a) social operators in private health care plans. The survey results indicated that : a) the demands and duties for certain social service, are associated with the redevelopment of the capital, whose requirements and responsibilities professionals have with their needs, particularly the guarantee of profit, services rendered; b) in the conditions of work there is a trend of insecurity uncertainty and dismantling of professionals; c) the answers professionals suffer the limits and contradictions present in the daily training, mainly depending one the characteristics of management and operation of the operators, which has professional relative autonomy

Trabalhadores por conta própria: O trabalho dos vendedores ambulantes da passarela do Natal shopping e do Via Direta

This study aid to understand the work conditions of street vendors located on the sidewalks of two malls in Brazil Northeast Natal / RN - Both malls Natal Shopping and Via Direta, to analyze their inclusion in the informal economy and to study the supposed autonomy provided by work as self-employment in its both aspects economic and social analyzing the importance on the condition of "masters of their own business" has for the street vendors, as an alternative to not submission to the figure of the boss, that represents the exploitation of one class over another. The theoretical and methodological aspects that support this study was aimed in discussion on the restructuring of production, considering its effects on the world of work, pointing to unemployment as one of the potencies element of excluded processes that exciting workers to engage in the informal market. Informality is presented as a survival strategy and as integrating part of the reproduction of capital. This research was conducted under a critical perspective, whish has been utilized quantitative and qualitative analyses. The results of this study format questions that provided during the research process the socio-economic characterization of workers, main cause of this study, and how street vendors expres their status of workers as self-employed for their work, and the perception that they have on their form of inclusion in the informal market.

Um ambiente para especificação e execução AD-HOC de processos de negócio baseados em serviços Web

Recently the focus given to Web Services and Semantic Web technologies has provided the development of several research projects in different ways to addressing the Web services composition issue. Meanwhile, the challenge of creating an environment that provides the specification of an abstract business process and that it is automatically implemented by a composite service in a dynamic way is considered a currently open problem. WSDL and BPEL provided by industry support only manual service composition because they lack needed semantics so that Web services are discovered, selected and combined by software agents. Services ontology provided by Semantic Web enriches the syntactic descriptions of Web services to facilitate the automation of tasks, such as discovery and composition. This work presents an environment for specifying and ad-hoc executing Web services-based business processes, named WebFlowAH. The WebFlowAH employs common domain ontology to describe both Web services and business processes. It allows processes specification in terms of users goals or desires that are expressed based on the concepts of such common domain ontology. This approach allows processes to be specified in an abstract high level way, unburdening the user from the underline details needed to effectively run the process workflow

Políticas públicas e as transformações socioespaciais correlacionadas ao turismo no município de Caicó: uma análise do período 2000 a 2010

The study presents an approach on planning, sociospatial transformations and public touristic policies implemented between 2000 and 2010 in Caicó, encompassing people from the government, private sector and the population of the municipality and informal traders who use the leisure facilities and services arranged in place. As the main goal, the research intends to analyze the performance of public and private sectors correlated to the touristic activity in Caicó city and their reflections in the process changes sociospatial. The dissertation is structured in order to carry out an investigation into the role of public policies to the development of a location with touristic potential, in this case, the municipality of Caicó; to investigate public policies implemented in the touristic industry of Rio Grande do Norte, particularly the actions of PRODETUR-Nordeste focused on the development of the tourism in the countryside, affecting particularly the region of Seridó region and the municipality of Caicó, and, finally, to check the main changes sociospatial verified in Caicó between 2000 and 2010. Cultural issues and certain natural beauties can be seen as attractions that can attract tourist demand, taking into consideration the awakening increasingly more evident quest by the tourist for knowledge of the peculiarities of the region. Several authors have worked in this view, pointing to the cultural aspects of the region as elements that are able to boost the touristic activity. The questions raised in this study was based on a literature, based mainly on authors like Beni, Dias, Cruz, Azevedo and Morais. To obtain the necessary data in the analysis, the methodological procedures used in intensive direct observation, using interviews, applied together with the public representatives who are acting as leaders of the political actions related to tourism in the municipality and members of the private sector related to tourism services such as lodging establishments, food and travel agency and, finally, the local people and informal traders benefited directly or indirectly, with the touristic resources and structure. These research agents were investigated by means of structured forms such as support for analysis. Was detected in the survey that the leisure facilities and services installed in the last decade in the city of Caico has a priority the population of the municipality, is necessary to emphasize that the residents interviewed perceive the importance of these tools for tourist activity. It was also found that the public sector is the main responsible for the observed changes. Therefore, proved to be relevant to study the role public private sector partnerships and population influences, considering that this analysis may contribute to the work of researchers, public administrators and businessmen, may serve as a norteador for planning and development of tourism in the city of Caico

Lazer e urbanização: a dinâmica do setor de serviços no litoral de Parnamirim e Nísia Floresta - RN

The research here undertaken analyzes the process of urbanization on the coast of Panamirim - RN and Nísia Floresta - RN, arising from leisure, the main leisure expression was considered the second residence and coastal tourism. The leisure promoted the growth of businesses and public and private services to meet consumer demand in that area, which initially occurred with users of second home, and which also gradually begin to occupy the coastline of these municipalities in 1980 and more recently with the development of tourism in the 1990s until now. To undertake such an analysis, we did the georeferencing about the trade and also public and private services of that coast, characterizing them; evaluated the extent to which services deployed in this area meets the demands of tourists and users of second residence; it was also identified how the centrality of Natal interferes in the expansion of services in these locations. The spatial area of research includes the coastal municipalities of Parnamirim and Nísia Floresta, considering the limits of the census of the Instituto Brasileiro de Geografia e Estatística- IBGE, and about the time frame, it was considered the 1990s to the present day. The methodology consists of: 1. survey and reading of the literature related to the researched topic, serving as the theoretical analysis in the construction of the object studied; 2. collection and organization of secondary data by the IBGE and tourism sectors of the State of Rio Grande do Norte, Natal and main municipalities of the research; 3. Questionnaires and / or interviews with the traders, service providers, tourists, users of second homes, local residents, and government. The analysis of such data collected allowed the preparation of graphs, maps and tables that illustrate the results obtained in the research field, basing so the study. The relevance of the study is shown by the extensive survey data involving agents of the research, including tourists, users of second homes and, above all, the data for the service sector that did not exist in the analyzed area. The study results identified in the area analyzed the emergence of three new centers, arising from the urbanization process from leisure, one of them located in the municipality of Nísia Foresta Beach in Barra de Tabatinga, and two in Parnamirim, more specifically in locality Pium and Beach Pirangi do Norte. It was further observed that, being located in tourist areas, the main feature of these new centers is seasonality

A contribuição da asstênia técnica no desenvolvimento desenvolvimento de projetos de assentamento no estado do Rio Grande do Norte

The public policies must have as their aimed the primordial at improving quality of life of families of a given population, however, its performance must be constantly monitored and evaluated scoped to ascertain whether these policies are reaching those goals. This work consisted in search of bibliographies and analysis that addressed the historical evolution of the debate on the subject of agrarian reform in Brazil as public policy and on the policy of technical assistance and rural extension, and collecting data in loco, in order to assess whether the actions implemented under this latter contribute to improvements in local development of settlements projects (PA) land reform in the state of Rio Grande do Norte (RN), this given the constant presented criticisms regarding their effectiveness, considering that it is difficult to empirically differentiate settlements they received of those who did not receive the technical assistance services. In this way, was held the data collection for comparison of characteristics (social organization, relationship with the local environment, form of producing and evaluation of technical assistance services) of two settlements in RN, being one you have received the technical assistance services and another who has not had access to these services in the past five years, at least, to confirm whether those who had access to the above services presents best features of social organization and the relationship with the local environment, mainly, which was confirmed in the results obtained, which still demonstrated that no significant differences on the forma to produce and of commercialization in PA studied. It was also found that the problems faced by families settled in PA studied resemble those seen verified in many other Brazilian states, especially as to how to use natural resources in the areas of land reform and the instability of the availability of technical assistance services. Should be guaranteed at continuity and universality of technical assistance services to settlements, seeking a higher focus on productive issues, which provide the income necessary for families settled can have a better quality of life

Análise da mobilidade urbana de Natal/RN a partir do uso de indicadores de sustentabilidade

In contemporary times, the urban mobility is presented as one of the main challenges of large and medium-sized Brazilian cities , it presents signs of unsustainability , above all due to the increase in motorized transport system , especially the individual . Thus , it is clear that mobility is considered of special interest for sustainable urban development , is facing a crisis that is reflected in negative externalities , particularly with regard to congestion , accidents , air pollution , social exclusion , among others. The complexity of these problems requires an integrated analysis based on the principles of sustainability . In this sense , trying to understand this problem and in the attempt to minimize its impacts, Costa (2008 ) proposed the Index of Sustainable Urban Mobility (I_SUM) with the goal of providing a methodology capable to assess relevant aspects of mobility , including social dimensions , political, economic and environmental . Given the above, was elected as the main objective of this study is to analyze urban mobility in Natal / RN from the perspective of sustainability . Like specific objectives will seek to analyze Natal´s urban mobility, using the I_SUM like a tool for both the city as a whole and for each of its four administrative regions; evaluate Natal s urban accessibility conditions and verify to what extent the access to urban services and equipment is facilitated or hindered because of the location and incomes of the population . For this, it was necessary to use bibliographic , documentary and field research . The index , which varies from 0.00 to 1.00, revealed for Natal an Global value of 0,510, and that refers to its administrative regions, it was found that there are very small percentage differences from the overall index calculated for the city . The performance of I_SUM by administrative region showed that although there are differences , the results were very similar , varying between 0,494 and 0,537. Particularly in relation to urban accessibility, it appears that Natal presents as an unequal city and this inequity , which is not only income is reflected in the issues related to accessibility and hence urban mobility